The Future of Early Cancer Detection? | Jorge Soto | TED Talks

譯者: lei liu 審譯者: Eric Chiang

Almost a year ago,

大概一年前

my aunt started suffering back pains.

我阿姨開始受到背疼折磨

She went to see the doctor

她去看了醫生

and they told her it was a normal injury

醫生說只是平常傷痛

for someone who had been playing tennis

就像一個打過三十年網球的人

for almost 30 years.

會受的傷痛

They recommended that she do some therapy,

醫生建議她去接受一些理療

but after a while she wasn't feeling better,

但過了一段時間還是沒有好轉

so the doctors decided to do further tests.

於是醫生進行了進一步檢查

They did an x-ray

做完X光檢查後

and discovered an injury in her lungs,

發現她傷病在於肺部

and at the time they thought that the injury

那時醫生還以為病疼

was a strain in the muscles and tendons

只是肋骨間肌肉和肌腱

between her ribs,

通常的拉傷

but after a few weeks of treatment,

但是經過幾周的治療

again her health wasn't getting any better.

阿姨的情況仍沒有好轉

So finally, they decided to do a biopsy,

最終，醫生決定進行組織切片

and two weeks later,

兩周後

the results of the biopsy came back.

切片檢查結果顯示為

It was stage 3 lung cancer.

肺癌第三期

Her lifestyle was almost free of risk.

阿姨的生活方式本是很健康的

She never smoked a cigarette,

她從不吸菸

she never drank alcohol,

也從不飲酒

and she had been playing sports

她保持運動

for almost half her life.

幾乎從不間斷

Perhaps, that is why it took them almost six months

也許，這也說明為什麼醫生幾乎六個月後

to get her properly diagnosed.

才給了她正確的診斷

My story might be, unfortunately,

不幸的是，這個例子可能

familiar to most of you.

很多人也經歷過

One out of three people sitting in this audience

在座各位有三分之一的人

will be diagnosed with some type of cancer,

可能診斷出有某種類型的癌症

and one out of four

並且四分之一的人

will die because of it.

可能因此喪生

Not only did that cancer diagnosis

不僅是癌症確診

change the life of our family,

會徹底改變一個家庭的生活

but that process of going

還有那個診斷的過程

back and forth with new tests,

反反覆覆，各種測試

different doctors describing symptoms,

與不同醫生描述病症

discarding diseases over and over,

討論病情，一遍又一遍

was stressful and frustrating,

這個過程伴隨著壓力和沮喪

especially for my aunt.

我阿姨深受其苦

And that is the way cancer diagnosis has been done

這種癌症診斷過程

since the beginning of history.

從以前到現在都是如此

We have 21st-century medical treatments and drugs

我們現在有 21 世紀的醫療技術和藥品

to treat cancer,

來治療癌症

but we still have 20th-century procedures

然而，對於癌症來說， 我們仍在應用 20 世紀的診斷程序

and processes for diagnosis, if any.

和診斷過程

Today, most of us have to wait for symptoms

今天，我們大多數人還必須等待

to indicate that something is wrong.

出現某種症狀才意識到危險

Today, the majority of people still don't have access

今天，大多數人仍然不知道

to early cancer detection methods,

早期癌症的檢測方法

even though we know

即使我們已經明白

that catching cancer early

及早發現癌症

is basically the closest thing we have

才是我們治癒癌症

to a silver bullet cure against it.

的最有效方式

We know that we can change this in our lifetime,

我和我的團隊堅信，在有生之年

and that is why my team and I

我們能夠改變這種情況

have decided to begin this journey,

於是我們開始了這一征程

this journey to try to make cancer detection

致力於在癌症初級階段

at the early stages

就檢測到癌症

and monitoring the appropriate response at the molecular level

並在分子層面上 對相應的治療反應給予監控

使其更輕鬆，更廉價，更聰明

easier, cheaper, smarter

and more accessible than ever before.

而且比以往更方便

The context, of course,

就在當下

is that we're living at a time

我們所處的時代背景下

where technology is disrupting our present

科技正在以指數級的速度

at exponential rates,

改變著我們當下的處境

and the biological realm is no exception.

生物領域也不例外

It is said today that biotech is advancing

據說，現今生物科技的進步速度

at least six times faster than the growth rate

至少六倍於

of the processing power of computers.

電腦處理速度的增長

But progress in biotech

然而，生物科技的進步

is not only being accelerated,

不僅是進步速度加快

it is also being democratized.

而且變得更加大眾化

Just as personal computers or the Internet

就像個人電腦和網路

or smartphones leveled the playing field

或智慧型手機在商業、政治、教育領域

for entrepreneurship, politics or education,

造成的扁平化影響一樣

recent advances have leveled it up for biotech progress as well,

現今的科技進步也在生物科技領域 開闢了一片新天地

and that is allowing

這使得

multidisciplinary teams like ours

像我們一樣的多學科團隊

to try to tackle and look at these problems

能夠嘗試從一個新途徑來研究和解決

with new approaches.

這些生物科技的課題

We are a team of scientists and technologists

我們團隊的科學家和工程師

from Chile, Panama,

來自智利、巴拿馬

Mexico, Israel and Greece,

墨西哥、以色列和希臘

and based on recent scientific discoveries,

基於最新的科學發現

we believe that we have found

相信我們已經發現了

a reliable and accurate way

一種可靠和準確的方式

of detecting several types of cancer

在非常初期時檢測出若干種癌症

at the very early stages through a blood sample.

而這只需血液樣本就可以完成

We do it by detecting a set of very small molecules

我們的方法是，檢測一組小血液分子

that circulate freely in our blood

該類血液分子在我們血液裡自由流動

called microRNAs.

我們稱之為：微 RNAs

To explain what microRNAs are

為了解釋什麼是微RNAs

and their important role in cancer,

及它在癌症檢測中的作用

I need to start with proteins,

我們從蛋白質開始說起

because when cancer is present in our body,

當癌症開始在我們身體裡出現

protein modification is observed

我們觀察到，在所有癌細胞中

in all cancerous cells.

蛋白質出現了改變

As you might know,

眾所周知

proteins are large biological molecules

蛋白質是一種大型生物分子

that perform different functions within our body,

在我們身體內承擔不同功能

like catalyzing metabolic reactions

例如，促進新陳代謝反應

or responding to stimuli

對外部刺激發生反應

or replicating DNA,

或是進行 DNA 複製

but before a protein is expressed or produced,

但是，在蛋白質表達或產出之前

relevant parts of its genetic code

存在於 DNA 中的

present in the DNA

相關遺傳密碼

are copied into the messenger RNA,

被複製到傳訊息的核糖核酸 (RNA) 中

so this messenger RNA

這種傳訊息的核糖核酸

has instructions on how to build a specific protein,

攜帶著指令來產生出特定一種蛋白質

and potentially it can build hundreds of proteins,

雖然它隱含製造數百種蛋白質的訊息

but the one that tells them when to build them

但其中有一段訊息 能決定何時生產蛋白質

and how many to build

及生產多少

are microRNAs.

這部分就是微 RNAs

So microRNAs are small molecules

所以，微 RNAs 就是 可以調節基因表達的小型分子

that regulate gene expression.

與 DNA 攜帶固定訊息不同

Unlike DNA, which is mainly fixed,

microRNAs can vary depending on internal

微 RNAs 在任意時間

and environmental conditions at any given time,

能根據內外環境不同而變化

telling us which genes are actively expressed at that particular moment.

它決定了哪種基因 在特定時刻被有效表達

And that is what makes microRNAs

這就是為什麼微 RNAs 有希望成為

such a promising biomarker for cancer,

癌症檢測的生物標記的原因

because as you know,

我們知道

cancer is a disease of altered gene expression.

癌症是一種基因表達變異產生的疾病

It is the uncontrolled regulation of genes.

是基因調節的失控所致

Another important thing to consider

另一個重要問題是

is that no two cancers are the same,

沒有任何兩種癌症是相同的

but at the microRNA level, there are patterns.

但在微 RNAs 層面上 是可以進行分類的

Several scientific studies have shown

若干科學研究表明

that abnormal microRNA expression levels

異常微 RNAs 的表達

varies and creates a unique, specific pattern

會產生不同而各自獨特的類型

for each type of cancer,

對應各種不同類型的癌症

even at the early stages,

即使在癌症最初階段

reflecting the progression of the disease,

微 RNAs 也能反應出病症的發展過程

and whether it's responding to medication

以及藥物治療是否有效

or in remission,

或是否處於病症緩解中

making microRNAs a perfect,

這使得微 RNAs 成為一個極其有效

highly sensitive biomarker.

非常靈敏的生物標記

However, the problem with microRNAs

可是，微 RNAs 的困難在於

is that we cannot use existing DNA-based technology

我們無法使用現有基於 DNA 的技術

to detect them in a reliable way,

來可靠地檢測它

because they are very short sequences of nucleotides,

由於微 RNAs 是非常短的核酸序列

much smaller than DNA.

遠遠小於 DNA

And also, all microRNAs are very similar to each other,

並且，所有的微 RNAs 之間非常相似

with just tiny differences.

差別極其微小

So imagine trying to differentiate two molecules,

就像試著去分辨出

extremely similar, extremely small.

兩個極其類似、極其微小的分子

We believe that we have found a way to do so,

我們認為已經發現一個分辨的辦法

and this is the first time that we've shown it in public.

這是我們首次公佈於眾

Let me do a demonstration.

我來示範一下

Imagine that next time you go to your doctor

想像你下次去看醫生

and do your next standard blood test,

要做一次血常規檢測

a lab technician extracts a total RNA,

一名實驗技術員提取了一條完整 RNA

which is quite simple today,

這在當今是很簡單的

and puts it in a standard 96-well plate like this one.

然後放入一個這樣的標準 96 孔盤中

Each well of these plates

這些標準試劑盤中，每一個孔中

has specific biochemistry that we assign,

都有我們預先分配好的特定生化試劑

that is looking for a specific microRNA,

以對應找出特定微 RNAs

acting like a trap that closes

這看來像一個設置好的陷阱

only when the microRNA is present in the sample,

只有當血液樣本中的微 RNAs 被檢測到

and when it does, it will shine with green color.

它開始閃現綠光

To run the reaction,

為完成這一反應

you put the plate inside a device like this one,

你要把試劑盤放入這樣一個設備當中

and then you can put your smartphone on top of it.

接下來把智慧型手機放在它上方

If we can have a camera here

請把攝影機對準這裡

so you can see my screen.

讓大家可以看到我的手機螢幕

A smartphone is a connected computer

手機和電腦連接在一起

and it's also a camera,

手機同時也是攝影機

good enough for our purpose.

足夠實現我們的目標

The smartphone is taking pictures,

手機在照相

and when the reaction is over,

當反應結束後

it will send the pictures

手機把圖片

to our online database for processing

發送到我們的 線上數據庫中進行處理

and interpretation.

和解讀

This entire process lasts around 60 minutes,

全過程大約持續 60 分鐘

but when the process is over,

當程序結束後

wells that shine are matched with the specific microRNAs

閃光的試劑孔與特定微 RNAs 配對分析

and analyzed in terms of how much and how fast

根據閃光的亮度和頻率得出分析結果

they shine.

And then, when this entire process is over,

當全部過程完成後

this is what happens.

這是我們得到的結果

This chart is showing the specific microRNAs

這張圖顯示了血液樣本中 所含的特定微 RNAs

present in this sample

和它們隨著時間的變化反應

and how they reacted over time.

Then, if we take this specific pattern of microRNA

接下來，我們將這一樣本中的 微 RNAs 的特定類型

of this person's samples

總結出來

and compare it with existing scientific documentation

與現有的科學文獻進行比較

that correlates microRNA patterns

由於這些文獻已將特定的微 RNAs 類型

with a specific presence of a disease,

與特定的疾病表現進行了關聯

this is how pancreatic cancer looks like.

我們檢測出樣本結果為胰腺癌

This inside is a real sample

剛檢測出來的胰腺癌樣本

where we just detected pancreatic cancer.

是一個真實的案例

(Applause)

（掌聲）

Another important aspect of this approach

我們方法的另一重要部分是

is the gathering and mining of data in the cloud,

在雲端進行數據的收集和整理

so we can get results in real time

這使我們能即時得到檢測結果

and analyze them with our contextual information.

並與相關訊息結合分析

If we want to better understand

如果我們希望更加了解

and decode diseases like cancer,

和揭秘類似癌症這樣的疾病

we need to stop treating them

我們應該停止那種 治療突發、孤立疾病的治療方式

as acute, isolated episodes,

and consider and measure everything

開始分析和評估所有因素

that affects our health on a permanent basis.

所有會影響我們長期健康的因素

This entire platform is a working prototype.

這一檢測系統還是一個原型機

It uses state-of-the-art molecular biology,

它應用了最先進的分子生物科技

a low-cost, 3D-printed device,

通過低成本的 3D 列印技術製作

and data science

及數據庫技術

to try to tackle one of humanity's toughest challenges.

來嘗試解決一個人類最艱難的挑戰

Since we believe early cancer detection

我們相信，癌症早期檢測方法

should really be democratized,

應該被推廣普及化

this entire solution costs at least 50 times less

我們的整套檢測方案相對目前的檢測方法

than current available methods,

費用節省至少 50 倍

and we know that the community can help us

我們也知道 相關行業的關注能幫助我們

accelerate this even more,

更迅速完善推廣這一方案

so we're making the design of the device

現在我們將設備的設計方案

open-source.

免費公開

(Applause)

（掌聲）

Let me say very clearly

你們要知道

that we are at the very early stages,

我們目前仍處於起步階段

but so far, we have been able

但我們已經可以

to successfully identify the microRNA pattern

成功分辨出了 一些癌症的微 RNAs 類型

of pancreatic cancer, lung cancer,

如胰腺癌、肺癌

breast cancer and hepatic cancer.

乳腺癌、肝癌

And currently, we're doing a clinical trial

目前，我們正在進行一項臨床試驗

in collaboration with the German Cancer Research Center

實驗是與德國癌症研究中心合作

with 200 women for breast cancer.

有 200 位女性參與的乳癌臨床試驗

(Applause)

（掌聲）

This is the single non-invasive,

這是一個單項的、無創傷

accurate and affordable test

準確和可負擔的檢測方案

that has the potential to dramatically change

可能會徹底改變

how cancer procedures and diagnostics

以往癌症的診斷程序和診斷方法

have been done.

Since we're looking for the microRNA patterns

因為我們檢測的是任意時間下

in your blood at any given time,

血液內的微 RNAs 類型

you don't need to know which cancer you're looking for.

所以你不必知道 所要檢測的特定癌症類型

You don't need to have any symptoms.

你也不用等到感覺到有任何症狀

You only need one milliliter of blood

只需要一毫升血液樣本

and a relatively simple array of tools.

和一系列相對很簡單的工具

Today, cancer detection happens mainly

當前，癌症檢測通常發生於

when symptoms appear.

患病症狀顯現後

That is, at stage 3 or 4,

這已經是癌症的第三或四階段

and I believe that is too late.

我認為這已經太遲了

It is too expensive for our families.

對一個家庭來說代價太大了

It is too expensive for humanity.

對全人類來說代價也太大了

We cannot lose the war against cancer.

我們不能在與癌症的鬥爭中失敗

It not only costs us billions of dollars,

失敗的損失不僅是無數的金錢

but it also costs us the people we love.

還會失去我們所愛的人

Today, my aunt, she's fighting bravely

如今，我的阿姨正勇敢抗爭著

and going through this process with a very positive attitude.

她以積極樂觀的態度面對這一過程

However, I want fights like this

可是，我還要努力把這樣的抗爭

to become very rare.

變得越來越少出現

I want to see the day

我希望有一天

when cancer is treated easily

癌症可以輕鬆治癒

because it can be routinely diagnosed

因為，在常規體檢中

at the very early stages,

初期癌症就可以檢測到

and I'm certain

我堅信

that in the very near future,

不久的將來

because of this

因為這套檢測系統

and other breakthroughs that we are seeing

和其他生命科學領域

every day in the life sciences,

不斷出現的突破

the way we see cancer

我們看待癌症的方式

will radically change.

將會根本改變

It will give us the chance of detecting it early,

對癌症，我們將有機會及早發現

understanding it better,

深入了解

and finding a cure.

徹底治癒

Thank you very much.

感謝大家

(Applause)

（掌聲）